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Doctor fights to put the care back in medicare: Goar

Two months have passed since Barbara Hall released her eye-opening report on discrimination against people with mental health disabilities. The public response has been unlike anything the Ontario human rights commissioner has seen in her six years at the helm.

One of the report’s most disturbing revelations was that discrimination against patients with psychiatric disorders is deeply embedded in Ontario’s health-care system. Human rights investigators found that doctors, nurses and paramedics ridicule individuals with mental disabilities, withhold treatment, use demeaning terms to their faces, and turn them away on the assumption that they’re junkies seeking drugs.

Most medical practitioners denied or dismissed these findings. One did not.

Here, with his permission, is what Dr. Brian Hodges, Vice-President Education at the University Health Network said: “These comments are both familiar and disheartening to me. Some of the examples of thoughtless labelling and hostile or dismissive attitudes are too common in health-care settings.”

What is especially discouraging, Hodges said, is that medical graduates who are taught to treat all patients with respect fall into bad habits when exposed to poor role models. “Educators in Canada are increasingly concerned about the presence of a ‘hidden curriculum’ which serves to undo the overt teaching about communication skills, empathy and professional values that characterize our health-care education programs. Dismissive or discriminatory attitudes are unfortunate when they are encountered anywhere in society and they’re doubly disturbing when they come from professionals whose job is to care.”

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Fortunately, his letter didn’t end there. He wrote about an initiative he and a coalition of like-minded doctors, nurses, therapists and medical educators have launched to put the “care” back in health care.

The group, known as Associated Medical Services (AMS), aims to make compassion as important as technical expertise in the delivery of health care. It believes science has outpaced social responsibility. To get the two tracks of health care back in balance, AMS members are urging their peers to treat their patients as human beings, not clinical problems. That means explaining procedures in everyday language and taking into account factors such as their mental health, family circumstances, housing and access to expensive medications.

Last year AMS launched a new campaign called the Phoenix Project: A Call to Caring. Its intention is to implant and sustain these practices in large health-science centres and then branch out to community hospitals, local clinics and diagnostic and rehabilitation facilities.

Although the project, led by Hodges, was conceived before Hall announced her findings, there is an obvious connection. If medical practitioners treated their patients with respect, the incidents documented by human rights investigators wouldn’t have happened.

One woman was told by her surgeon: “Had I known you were crazy, I wouldn’t have operated on you.”

A man who arrived at a hospital emergency department complaining of severe abdominal pain would not have been left waiting for 10 hours before someone realized he needed urgent surgery. He was a recovering addict on methadone treatment.

A paramedic told the commission his colleagues joked at lunch about picking up “crazies” and “junkies.”

It will take more than a dedicated minority of health-care workers to turn the tide. But it’s good to know they’re implanting their ideas in Ontario’s faculties of medicine and teaching hospitals, lobbying policy-makers and spreading the word at conferences and professional gatherings.

It will take more than a tenacious human rights commissioner to root out discrimination. But it’s good to know Hall is urging the Ontario government to update its laws and standards, willing to intervene in court challenges against doctors accused of denying services to people with mental disabilities, and prepared to initiate cases at the Human Rights Tribunal of Ontario.

What is missing is the most powerful lever of all: public pressure. When voters take a stand against prejudicial medicare, political leaders will get off the sidelines.

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